Hormone Replacement Therapy (HRT) and Your Heart Health: What Women in Their 40s, 50s, and Beyond Need to Know | Dr Chan Po Fun, Singapore
- Dr Chan Po Fun
- Aug 10
- 4 min read
Updated: Sep 8
Menopause is not the end — it’s a turning point. With the right support, you can thrive and protect your heart too.
Many women see me during menopause because “something feels off.” They’re sleeping poorly, feeling anxious, noticing belly weight gain, or sensing that their heart isn’t quite right.
During a check-up, we assess cardiovascular risk and run the necessary investigations. Sometimes, the heart is in great shape — and symptoms are due to menopause. One common treatment option is hormone replacement therapy (HRT).
And the question I’m asked most often is:
👉 “Is hormone replacement therapy (HRT) safe for my heart?”
The answer is not a simple yes or no. It depends on your age, your symptoms, and your heart risk. Here’s what I tell my patients — woman to woman, heart to heart.
Let me walk you through what I usually share with my patients — woman to woman, heart to heart.
When your ovaries stop producing oestrogen, you lose an important protective effect on your heart and blood vessels.
As oestrogen levels fall, you may experience:
Higher LDL (“bad” cholesterol)
Lower HDL (“good” cholesterol)
Stiffer arteries and higher blood pressure
Weight gain, especially belly fat
Fatigue, brain fog, and poor sleep
These changes increase the risk of:
Coronary artery disease
Heart failure with preserved ejection fraction (HFpEF)
Atrial fibrillation and other arrhythmias
This is why menopause isn’t just about hormones — it’s a turning point in cardiovascular health.
Where Does Hormone Replacement Therapy (HRT) Fit In?
Hormone replacement therapy (HRT) can relieve hot flushes, night sweats, mood changes, and vaginal dryness.
But how does it affect your heart health?
🔍 What research shows:
If HRT is started within 10 years of menopause (especially before age 60), it may lower the risk of heart disease in some women.
If started after age 65–70, it may raise cardiovascular risk, particularly in women with existing heart disease.
This is called the “timing hypothesis”, and it’s why Hormone Replacement Therapy (HRT) must be personalised.
When Hormone Replacement Therapy (HRT) May Be a Safe Choice
You may benefit from Hormone Replacement Therapy (HRT) if you:
Are under 60 years old
Are within 10 years of your last period
Have moderate to severe menopause symptoms
Do not have established heart disease or stroke history
In these cases, Hormone Replacement Therapy (HRT) may improve both quality of life and heart health, when carefully prescribed.
When Hormone Replacement Therapy (HRT) May Not Be Suitable
Hormone Replacement Therapy (HRT) is usually not recommended if you have:
A history of heart attack, stroke, or blood clots
Uncontrolled high blood pressure
Breast or endometrial cancer
Are many years past menopause without symptoms
This is why a full review, including blood pressure, lipid panel, glucose, ECG or echocardiogram, is so important.
My Usual Recommendations
When a woman considers Hormone Replacement Therapy (HRT), we review:
Symptoms – how much they affect quality of life
Timeline – when menopause began
Risks – family history, cholesterol, diabetes, autoimmune conditions
Preferences – natural vs medical approaches
If Hormone Replacement Therapy (HRT) is suitable, I often recommend:
Transdermal estrogen (patch or gel) – lower clot risk than tablets
Lowest effective dose – reviewed yearly
Lifestyle support – diet, exercise, sleep, stress management
Ongoing heart health monitoring
How I Can Help
As a female cardiologist in Singapore focusing on women’s heart health, I work closely with women navigating menopause and beyond.
At my clinic, we provide:
✔️ Comprehensive heart health screening
✔️ Cardiovascular risk assessments tailored to menopause and midlife
✔️ Discussion on Hormone Replacement Therapy (HRT) and Heart Health
✔️ Compassionate, personalised care — no one-size-fits-all advice
💬 “Your menopause journey is uniquely yours. With the right care, you can feel like yourself again — and protect your heart in the process.”
Ready to Take the Next Step?
If you’re in your 40s, 50s, or 60s and wondering if HRT is right for you, don’t guess.
Your menopause journey is uniquely yours. Don’t settle for confusion, fear, or one-size-fits-all advice. With the right information, you can feel like yourself again — and protect your heart in the process.
Quick, personalised 20-minute heart check-up with Dr Chan Po Fun, female cardiologist specialising in Women’s Heart Health
FAQ: Hormone Replacement Therapy (HRT) and your Heart
Q: Is Hormone Replacement Therapy (HRT) safe for my heart?
A: It can be, especially if started within 10 years of menopause and before age 60. Safety depends on your personal risk profile.
Q: Which type of Hormone Replacement Therapy (HRT) is safest for heart health?
A: Transdermal estrogen (patch or gel) is often preferred due to lower clot risk compared to oral forms.
Q: Can Hormone Replacement Therapy (HRT) prevent heart disease?
A: HRT is usually prescribed for relief of menopausal symptoms, and not for prevention of heart diseases. When started early, it may reduce cardiovascular risk in some women.
Q: Who should not take Hormone Replacement Therapy (HRT)?
A: Women with a history of heart attack, stroke, blood clots, or certain cancers are usually not advised to take HRT.
Q: Do I need heart health screening before starting Hormone Replacement Therapy (HRT)?
A: Yes. Blood pressure, cholesterol, and glucose levels are checked to assess your cardiovascular risk before starting. Sometimes, further heart evaluation is recommended before deciding.
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